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EMG 95886

Luz Posted Tue 15th of January, 2019 13:47:42 PM
I have a question; the neurologist documented an EMG study the following way: L. Tibialis anterior, L.Gastrocenemius (Medial Head),L. Vastus Lateralis,L. First dorsal interosseous, L. Bicepts brachii, L. Triceps brachii, L.C6 paraspinal,L.C5 paraspinal, L. L5 paraspinal. He conducted the study along with NCS. He billed for 2 units of 96886. The physician said the C6 & C7 counts towards the code. Would you please explain what counts and don't count toward the code. Our coder say it supports 96885. Could you please tell me who is correct. If you know of any documentation that tell what paraspinal can be counted ,please direct me to it. Thank You.
SuperCoder Answered Wed 16th of January, 2019 03:57:58 AM

Hi Luz,

 
Thanks for your question. 
 

When your physician does electromyography (EMG) along with nerve conduction studies (95907-95913), report the EMG with add-on codes, depending upon the testing of extremities or axial muscles:

 

+95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure])

 

+95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure])

 

+95887 (Needle electromyography, non-extremity [cranial nerve supplied or axial] muscle[s] done with nerve conduction, amplitude and latency/velocity study [List separately in addition to code for primary procedure]).

 

If the neurologist tests 5 or more muscles in a single extremity, then you would report 1 unit of +95886.

 

If the neurologist tests less than 5 muscles in a single extremity, then you would report 1 unit of +95885.

 

Use +95887 when a study of the cervical paraspinal muscle(s), or the lumbar paraspinal muscle(s) is performed with no corresponding limb study (95885 or 95886) on the same day.

 

EMG codes include testing of the related paraspinal areas, i.e. cervical paraspinal muscles for upper extremity testing and lumbar paraspinal muscles for the lower extremity testing. You would not separately report EMG testing of these paraspinal muscles when performed as part of the extremity EMG diagnostic testing.

 

NOTE: As per your documentation, following number of muscles have been studied:

  • 5 muscles are studied on Left lower extremity (L. Tibialis anterior, L.Gastrocenemius (Medial Head), L. Vastus Lateralis, L. First dorsal interosseous, L. L5 paraspinal)
  • 4 muscles are studied on Left upper extremity (L. Bicepts brachii, L. Triceps brachii, L.C6 paraspinal, L.C5 paraspinal)

 

Now, for lower extremity, report 1 unit of +95886 (5 muscles) and for upper extremity, report 1 unit of +95885 (4 muscles).

 

Physician is correct when he says that C6 & C7 count towards the code +95886.

 

The coder is correct when he says to report code +95885.

 

For more information, please read CPT guidelines related to these codes.

 

Please feel free to write if you have any question.

 

Thanks

Luz Posted Thu 17th of January, 2019 07:54:30 AM
Thank you this is helpful! Is there other paraspinals that can be use towards the code? If yes, which? Is there a guideline that you can refer me to regarding which paraspinal can be use towards the codes? Thank you.
Luz Posted Thu 17th of January, 2019 08:57:43 AM
I apologize but I did not listed all the paraspinal in the question above. Therefore, I am asking for you to please provide your input again. Neurologist billed EMG study- 95886x2 for ( Lower and upper extremity), and documented as follow: Tibialis anterior, L.Gastrocenemius (Medial Head),L. Vastus Lateralis,L. First dorsal interosseous, L. Bicepts brachii, L. Triceps brachii, L.C6 paraspinal,L.C5 paraspinal, L. L5 paraspinal. L.S1 paraspinal, L.T5 paraspinal, L.T6 paraspinal ,L.T10 Paraspinal, & L.T11 Paraspinal. Is the neurologist correct? The EMGs where done along with NCS-billed. Also, can you please tell me which of the paraspinal listed count towards the code-all listed? Thank You.
SuperCoder Answered Fri 18th of January, 2019 05:53:36 AM

Now the following number of muscles have been studied:

  • 7 muscles are studied on Left lower extremity (L. Tibialis anterior, L.Gastrocenemius (Medial Head), L. Vastus Lateralis, L. First dorsal interosseous, L. L5 paraspinal)
  • 4 muscles are studied on Left upper extremity (L. Bicepts brachii, L. Triceps brachii, L.C6 paraspinal, L.C5 paraspinal)
  • 4 muscles are studied on thoracic spine (L.T5 paraspinal, L.T6 paraspinal ,L.T10 Paraspinal, & L.T11 Paraspinal)

And the codes should be:

  • For lower extremity, report 1 unit of +95886 (7 muscles).
  • For upper extremity, report 1 unit of +95885 (4 muscles).
  • For thoracic muscles EMG, report 1 unit of 95869 (4 muscles). Codes 95860-95864 can be reported in combination with CPT code 95869 only if paraspinals between T3-T11 are studied.

Hope this helps.

 

Thanks

Luz Posted Fri 18th of January, 2019 08:31:57 AM
Hi Leesa, thank you for your explanation, is very helpful. Regarding the third bullet instructions; those codes are to be reported when there are no nerve conduction studies (NCS) performed in conjunction with these procedures during the same day. In my case we performed the NCS and EMG to this patient on the same day. Therefore, I think code 95869 does not apply-right? . Please clarify. Thank You,
SuperCoder Answered Mon 21st of January, 2019 02:05:09 AM

Hi Luz,

 

Thanks

 

You should report 95887 (Needle electromyography, non-extremity [cranial nerve supplied or axial] muscle[s] done with nerve conduction, amplitude and latency/velocity study [List separately in addition to code for primary procedure]) once per anatomic site (ie, cervical paraspinal muscle[s], thoracic paraspinal muscle[s], lumbar paraspinal muscle[s], chest wall muscle[s], and abdominal wall muscle[s]) when NCS is also performed along with EMG.

 

Hope this helps.

 

Thanks

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